Prosthesis Dysfunction Research Articles

Role of myocardial microRNAs in the long-term ventricular remodelling of patients with aortic stenosis.

We hypothesize that miRs are key players in the dynamics of the hypertrophy phenotype in aortic stenosis (AS) patients. In our study, we aimed to identify the transcriptional patterns (protein-coding transcripts and miRs) from myocardial sample biopsies that could be associated with the absence of left ventricular (LV) mass regression after aortic valve replacement (AVR) in patients with severe AS and LV hypertrophy. We prospectively included 40 patients with severe AS, LV hypertrophy, and preserved ejection fraction undergoing AVR. Myocardial biopsies obtained during surgery were analysed for transcriptomic analysis performed by next-generation sequencing. At a 1-year follow-up, no hypertrophy reversal was observed in about half of the patients in the absence of patient-prosthesis mismatch and prosthesis dysfunction of uncontrolled hypertension. Predictors of mass regression were assessed from clinical, echocardiographic, and biochemical variables as well as from 300 miRs obtained from myocardial specimens, allowing the identification 29 differentially expressed. miR-4709-3p was found as a positive independent predictor of hypertrophy regression together with high-sensitivity troponin T (cTNT-hs) as a negative predictor. Gene transcripts RFX1, SIX5, MAPK8IF3, and PKD1 were predicted as simultaneous targets of five upregulated miRs suggesting its importance in LV hypertrophy. In our cohort, tissue miR-4709-3p and cTNT-hs were independent predictors of hypertrophy regression. The hypertrophy reversal process will likely depend from a complex network where miRNAs may have an important role, allowing a potential opportunity for therapy.

Non-Obstructive Thrombosis of Mechanical Mitral Prosthesis: About a Case Report and Literature Review

Introduction: Mechanical mitral valve prostheses are vital for patients with mitral valve disease. While obstruction is a well-recognized complication, non-obstructive dysfunction remains less understood. We present a case of non-obstructive mechanical mitral prosthesis to highlight its clinical importance and management challenges. Case Presentation: A 45-year-old female, who had undergone mechanical mitral valve replacement 9 years prior, presented with dysarthria and facial paralysis. Transthoracic echocardiography revealed preserved prosthesis function with no apparent obstruction. However, transesophageal echocardiography confirmed the non-obstructive thrombosis of the mitral prothesis. We opted for a medical treatment consisting in optimizing anticoagulation with the addition of aspirin. The evolution was favorable with complete regression of the thrombus at the control TEO. Discussion: Non-obstructive mechanical mitral prosthesis is a rare entity, often characterized by atypical symptoms. This case emphasizes the importance of comprehensive assessment beyond prosthetic valve gradients. as well as the importance of combining several imaging methods, including radio cinema and TEO. Surgical intervention wasn’t necessary, as the medical treatment was sufficient. Conclusion: Non-obstructive mechanical mitral prosthesis dysfunction can be challenging to diagnose but is crucial to consider in symptomatic patients with mechanical valves. This case underscores the need for a multidimensional approach, including advanced imaging techniques, to uncover and manage non-obstructive prosthesis dysfunction, ultimately improving patient outcomes and quality of life.

(PM-01) SEXUAL SATISFACTION POST PENILE PROSTHESIS IMPLANTATION

Abstract Introduction Erectile dysfunction is defined as the persistent inability to achieve or maintain an erection sufficient for a satisfactory sexual relationship. In some cases, it is refractory to pharmacological treatments, or these treatments are contraindicated, leading to the consideration of using a penile prosthesis as a definitive treatment. While reported patient and partner satisfaction rates are high (82 – 97%), dissatisfaction has been found to be attributed to various reasons, including prosthesis dysfunction and/or unmet patient expectations regarding the quality of the erection and sexual satisfaction. Methods An analytical observational bidirectional cohort study approved by the institutional ethics committee was conducted. Subsequently, patients who underwent penile prosthesis implantation between January 2017 and June 2021 at a single center were identified. Results A total of 47 cases were analyzed, with an average age of 64 years. Overall satisfaction with the penile prosthesis implantation was 100%. 94.1% felt that their treatment expectations were met, 88.2% reported continuing to use this method, and 100% were satisfied with the duration of the erection. Conclusions A 100% overall global satisfaction rate was observed. High rates of sexual satisfaction in patients were evident, reaffirming the penile prosthesis as a safe procedure that should be offered as a third-line treatment or when a permanent solution is desired. Financing No conflict.

Transcatheter Intervention for Inoperable Tricuspid Surgical Prosthesis Dysfunction: Minimally Invasive Approach to Mitigate Heart Failure

What is the efficacy and safety of transcatheter tricuspid valve-in-valve implantation for patients with inoperable tricuspid surgical prosthesis dysfunction? Thirty-day mortality after greatly effective transcatheter treatment is 2 times less than the estimated surgical risk.

Specificity of long-term management of a woman patient of reproductive age after surgical mitral valve repair against the background of infective endocarditis

As a clinical case, we present the "portrait" of a woman patient with acquired mitral valve (MV) defect against the background of infective endocarditis which was diagnosed during the third trimester of pregnancy. The patient underwent mitral valve replacement surgery with biological prosthesis "KemKor" followed by two successful deliveries. In 18 years after the correction of the mitral valve defect, she developed valve prosthesis dysfunction therefore, she underwent endovascular transcatheter implantation of bioprosthesis by method "prosthesis-into-prosthesis" in the mitral position.This clinical case is unique in terms of the reasoning the biological prosthesis choice to correct acquired MV defect in a patient of reproductive age, the long-term period of the bioprosthesis functioning and the correction of further developed valve dysfunction using the techniques of transcatheter implantation.

C38 EARLY AND MID-TERM RESULTS FROM THE RESILIA AORTIC TISSUE VALVE ITALIAN REGISTRY (RES-ITA)

Abstract Objective The objective of our study is to evaluate safety, hemodynamic performance and durability of the new generation aortic bioprosthesis with Resilia Tissue. Methods RES-ITA Registry is the Italian multicenter registry created in 2017, enrolling patients who underwent isolated or combined AVR with Resilia tissue valve. The Registry was recently recognized by SICCH as the official national registry of Resilia tissue valve implantations, with Potenza’s Cardiac Surgery Unit as its coordinating center. Isolated AVR (50%) was performed predominantly through an upper J mini-sternotomy or a right anterior mini-thoracotomy, while combined procedures (50%) were performed in full sternotomy and included associated CABG, ascending aorta surgery, mitral valve repair or replacement, aortic annulus enlargement. For all patients, clinical and echocardiographic assessment were evaluated at discharge, 30 days, 6 months and every year after surgery. Results Between June 2017 and March 2022, about 1000 patients were included, coming from 13 Italian cardiac surgery centers. During last year, 6 more Italian centers have asked to join the Registry. Mean age was 57±11 years. Mean Euroscore II was 2.24±3.01%. Redo surgery was performed in 11%. Most frequently implanted valve sizes were 23 mm (30%), 25 mm (27.7%) and 27 mm (19%). Two-year freedom from all-cause mortality for isolated AVR and for all patients was 97.4±1.3% and 95.7±1.1%, respectively. Two-year freedom from major paravalvular leaks (≥2+/4) was 98.4±0.8; freedom from prosthesis thrombosis was 96.7±2 and freedom from prosthesis dysfunction (according to VARC-2 criteria) was 96.7±1.7. Mean gradient was 13.3±8.3 mmHg and maximum gradient was 23.2±16.2 mmHg at 2-year follow-up. Conclusions The new generation aortic prosthesis with RESILIA tissue demonstrates versatility of use, safety, good early and mid-term outcomes and hemodynamic performance. Further investigations and longer follow-up are needed to evaluate long-term durability.

P402 PROSTHETIC MECHANICAL VALVE THROMBOSIS: THE EXPERIENCE OF SALAM CENTRE FOR CARDIAC SURGERY (EMERGENCY NGO)

Abstract Mechanical heart valve (MHV) replacement in patients with rheumatic valve disease is common in Africa. MHV requires long–life anticoagulation (OAT) and managing this can be difficult. Prosthetic valve thrombosis (VT) is a pathological entity characterized by thrombus formation on the prosthetic structures, with subsequent prosthesis dysfunction. Salam Centre for Cardiac Surgery was built in Khartoum Sudan by Emergency NGO. Since April 2007 high–quality and free–of–charge medical and cardio–surgical treatment has been offered to patients. More than 10000 cardiac surgery, 80% of which for MHV replacement, were performed. The aim of the work is to analyze the characteristics of patients with VT, the risk factors and clinical follow–up. From Aug 1, 2018 to Nov 30, 2022, 287 VT involving 237 patients were collected.The incidence is 1.36% p/y. The most relevant risk factor was the interruption of anticoagulant therapy and irregular INR control (N. 142; 49,5%). In 101 cases (35,2%) a clinical factor (infection, pregnancy, eosinophilia, heart failure) was the main cause of VT. The diagnosis, suspected with the Transthoracic Echo and confirmed with fluoroscopy, was done at the OPD visit (32,4%) in asymptomatic or at triage for symptomatic patients (67,6%). 236 patients were admitted to Salam Centre.The treatments of choice were thrombolysis, performed with 2 different protocols, fast and low dose–slow infusion (Alteplase 25 mg./6 hrs), followed by Triple Therapy (TT) (Warfarin, LMWH and Aspirin) (N.189–65,8%), TT alone (N.44– 15,3%) or Warfarin and Aspirin (N.54–18,8%). 210 events (73,2%) ended with unblocked valve,24 events ended with the death of the patient (8,3%); low dose/slow infusion regimen had less deaths. Thrombolysis was more effective (unblockage 79,9%). Warfarin and Aspirin and not admission to Salam Centre were linked to less unblokage and high mortality rate. Conclusions The incorrect conduct of OAT represents the most relevant risk factor for VT.Many are the underlying causes, from economic and social factors to insufficient patient awareness. MOH intervention to offer free of charge INR check, but also patient education must be improved. VT is caused also by intercurrent clinical events such as pregnancy, infection. Eosinophilia represents a chapter that deserves a detailed study.Patients with history of VT must be followed by a dedicated clinic that aims to increase patient loyalty in order to intercept risk factors as early as possible.

P136 “THERE’S NO TWO WITHOUT THREE”: A STRANGE CASE OF RECURRENT CORONARY EMBOLISM

Abstract Background A 68 year–old woman with rheumatic heart disease underwent surgery replacement of aortic and mitral valves with mechanical prostheses 20 years ago, and since then has been in VKAs therapy. One year after the operation, she was hospitalized for ischemic stroke without relics. For detection of 2:1 block on the ECG Holter/24h a PM was implanted. After 4 years, she had an acute coronary syndrome (ACS) with VF (treated with DC–Shock). Coronary angiography (CA) showed no coronary stenosis. It was replaced PM to ICD. In 2017, she had a TIA and a mitral prosthesis dysfunction was detected from EET with hemidisk thrombosis. After CA, mitral valve replacement was performed but on the 2nd day after surgery she had an anterior STEMI caused by the occlusion of LAD. PTCA and stenting were performed. In October u.s. the patient was referred to the Emergency room for typical angina. An inferior–posterior STEMI was revealed to ECG. CA highlighted embolic occlusion of Cx and good result of prior LAD’s stenting. After multiple and ineffective attempts, invasive recanalization’s procedure was interrupted considering both patient’s high bleeding risk and embolic aetiology. Excluded prosthetic thrombosis and thrombophilic anomalies, patient was discharged in clinical stability with SAPT+ VKAs therapies. Discussion Coronary embolism (CE) represents 3% of ACS because the coronary arteries are protected from embolism thanks to their acute’s angle origin from the aorta. Embolism origin is various and it can originate from left (LAA, LVx, valvular, prosthetic structures) or right heart sections (paradoxical embolism in the case of PFO),generally during AF. In our case, prosthetic origin is the most probable embolic source as demonstrated by cerebral ischemic (TIA/stroke) and coronary events (first anterior then inferior–posterior STEMI) after valves surgery. Treatment consists of restoring antegrade flow without DES implantation, using if possible intracoronary thrombolysis or thromboaspiration. In secondary prevention, embolism sources removal and anticoagulant therapy are mandatory. In our case we recommended SAPT+VKAs with strict INR’s control (range 3.5–4). Conclusions Although CE is a rare and potentially fatal phenomenon it should be suspected in the absence of coronary atherosclerosis and in the presence of predisposing conditions such as those mentioned above. This case demonstrates that CE can occur in absence of prosthetic thrombosis with suboptimal INR control.

Follow-up of the aortic valve replacement surgery in a national reference hospital in Lima, Peru, period 2016-2019

Objective: To describe the perioperative characteristics of patients undergoing aortic valve replacement; as well as complications, mortality, follow-up and survival.
 Materials and methods: A retrospective study of patients operated between 2016 and 2019 was carried out. Pre, intra, and postoperative characteristics were determined, as well as clinical and echocardiographic follow-up. Student's t test was used to compare means. Overall survival and cardiovascular event-free survival were analyzed using the Kaplan-Meier method.
 Results:110 patients were included (59.1% male), the mean age was 65.2 ± 11.3 years, the majority with arterial hypertension (47.3%). The most frequent etiology was degenerative (47.3%). A mechanical prosthesis was implanted in 59.1%. In the postoperative period, a median mechanical ventilation time of 8 hours was observed, with an average stay in the ICU of 5.8 ± 6.7 days. The most frequent complications were atelectasis (21.8%), atrial fibrillation (19.1%), low output syndrome, pneumonia, and acute kidney injury (7.3% each). Hospital mortality was 5.5% (cardiogenic shock as the frequent cause). During follow-up at one year, there was an improvement from NYHA II-III functional class (pre-surgical) to NYHA I-II (p <0.001), prosthesis dysfunction was found in 13.3% (the majority due to paravalvular leak). Overall survival at 1, 3, and 5 years was 88,2 ± 3,1, 83.4 ± 3.6% y 74.3 ± 5.0%, respectively.
 Conclusions: Aortic valve replacement surgery in our setting implies an improvement in quality of life with good functional results, complication rate, and morbidity and mortality comparable with the world literature.

Cardiovascular computed tomography in the evaluation of post-TAVI prosthesis dysfunction: the thin line between hypo attenuated leaflet thickening and clinical valve thrombosis.

It is accepted that hypo attenuated leaflet thickening (HALT) can be detected in 12% and 32% of transcatheter aortic valve implantation (TAVI) patients on oral anticoagulation or dual antiplatelet therapy at 3 months, respectively.1 Clinically relevant TAVI thrombosis is rare, with up to 1% incidence.2 We present the case of an 86-year-old male with a history of ischemic cardiomyopathy, atrial fibrillation (on apixaban 5 mg BID), and 4 months post-TAVI (Sapien 3–29 mm) who presented to the Emergency Department with worsening dyspnea and elevated cardiac biomarkers: HS-Tn (1689 ng/L) and NT-proBNP (>5000 pg/mL). Echocardiogram showed new severe systolic dysfunction (left ventricular EF = 30%) and elevated gradients (compared to the basal post-TAVI study) with limited visualization of the valve (central figure, Panels A and B). He underwent invasive coronary angiography, which showed no coronary artery disease progression as to explain the clinical changes. Given the rapidly worsening clinical status, a cardiovascular computed tomography (CCT) was ordered over transesophageal echocardiogram for better evaluation. The CCT was acquired using retrospective gating without ECG dose modulation (IQon, Philips) for high-quality full-cycle images (Panels C–F). There was severe symmetrical tri-leaflet thickening with sparing of the distal tips (meniscal shape), classically described in HALT.3 The Hounsfield units were more consistent with thrombus (<100 HU) (Panel C), and significantly reduced tri-leaflet motion was also noted on functional images (see Supplementary data online, Video S1). Despite being treated with i.v. heparin and guideline-directed medical therapy for HFrEF, the patient developed refractory cardiogenic shock and expired. The best antithrombotic regimen for patients undergoing TAVI remains controversial.4 Bioprosthetic valve thrombosis involves a spectrum with different grades of clinical manifestation. The CCT is paramount for establishing the etiology of the dysfunction and providing prognostic information for patient management.5

Safety and efficacy of the INC bioprosthetic heart valve in humans.

Heart valve bioprostheses are the gold standard for aortic valve surgical replacement in selected patients. To evaluate the safety and efficacy of the National Institute of Cardiology (INC) bioprosthetic heart valve in humans. Single-center study that included 341 patients who underwent single surgical aortic valve replacement with INC heart valve. 318 implants were performed de novo (93%) and 23 as redo surgery (7%); STS scores were 1.4 and 1.8%, and follow-up was for 42 and 46 months, respectively. There were no differences in clinical complications or pacemaker implantation rate. Both groups maintained a normal LVEF. Overall improvement in functional class was observed, with worsening only in two patients of the de novo group. INC prosthesis dysfunction requiring surgical reintervention was observed in eight patients (4.65%) of the de novo group vs. one patient in the redo group. The INC heart valve is efficacious and safe, and is associated with a low rate of complications and functional class improvement during long-term follow-up. Prospective, comparative studies of this valve are required.

Modifiable and nonmodifiable risk factors in redo mitral surgery

Highlights. In the present study, we conducted a retrospective analysis redo mitral valve replacement due to prosthesis failure. Predictors of adverse events and death have been analyzed. The quality of obtained predictors was verified using ROC analysis.Aim. To analyze predictors of adverse events and death in redo mitral procedure for treating mitral bioprostheses failure.Methods. The retrospective registry study of catamnesis of patients undergoing treatment for mitral valve prosthesis dysfunction was carried out. The age and gender of patients, medical history, underlying and comorbid diseases, features of primary replacement and reoperation, durability of the primary prosthesis, adverse events and death after redo mitral valve replacement and others (more than 30 factors) were taken into account. Stepwise logistic regression was used for statistical processing. The quality of obtained predictors was verified using ROC analysis.Results. The results of the study have revealed that there are modifiable risk factors such as cardiopulmonary bypass time, ischemia time, and nonmodifiable risk factors like reoperation, baseline severity of the patient's condition, complications of median resternotomy, concomitant interventions on aortic valve during reoperation. Moreover, treating atrial fibrillation during primary replacement proved to have an overall protective effect.Conclusion. Тhe only modifiable factors that can be influenced during redo mitral valve replacement due to biological prosthesis failure are cardiopulmonary bypass duration and aortic cross-clamping time.

Redo heart valve replacement in patients with dysfunction of biological prostheses

Redo heart valve replacement in patients with dysfunction of biological prostheses

Redo aortic root surgery post-Ross procedure.

Despite numerous advantages of the Ross procedure, it presents a risk of late autograft and right ventricular outflow tract conduit failure. This study aimed to analyze the outcomes of autograft dysfunction reoperations using autograft-sparing and root replacement techniques. Between 2015 and 2023, 49 patients underwent redo root surgery in our institution. Autograft valve-sparing procedures (VSP) were performed in 20 cases and the Bentall procedure (BP) in 29 patients. The short and long-term clinical outcomes along with echocardiographic results of VSP and BP were investigated. Overall early mortality rate was 2.0% with no significant difference between the groups. Severe autograft valve insufficiency at the time of redo (OR 4.07, P = 0.03) and patient age (OR 1.07, P = 0.04) were associated with a valve replacement procedure instead of VSP. The median follow-up duration was 34 months. No late deaths occurred in either group. Freedom from VSP failure and aortic prosthesis dysfunction were 93.8% and 94.1% in the VSP and BP groups, respectively. No reoperations were necessary in either group. Redo aortic root surgery can be safely performed in patients with autograft failure. Both root replacement and autograft valve-sparing procedures demonstrated acceptable results at mid-term follow-up. Early redo surgery pre-empting severe aortic insufficiency increases the likelihood of preservation of the dilated autograft valve.

The immediate results of surgical treatment of an ascending aortic aneurysm in conjunction with a stenotic lesion of the aortic valve

Introduction. Ascending aortic aneurysms with bicuspid and tricuspid aortic valves have completely diff erent nature of origin. There is a large number of studies focusing on the negative effect of bicuspid aortic valve on the prognosis of this disease. However, studies regarding the impact of tricuspid aortic valve on ascending aortic aneurysms are extremely rare. In this regard, the purpose of our work was.Aim: To analyze the early results of simultaneous surgical treatment.Material and Methods. The retrospective study included 73 patients with aortic valve stenosis in combination with ascending aortic aneurysm. Patients were divided into two groups: group 1 comprised patients with bicuspid aortic valve and aortic aneurysm; group 2 comprised patients with tricuspid aortic valve and aortic aneurysm. All the examined patients underwent prosthetics of the aortic valve with simultaneous prosthetics of the ascending aorta as planned. Echocardiographic parameters and multispiral computed aortography were evaluated before and after surgery.Results. The patients were comparable in baseline characteristics. The incidence rates of acute cerebrovascular accident, respiratory failure requiring prolonged respiratory support, acute kidney injury, and bleeding requiring re-operation were 3.7 vs. 0% (p = 0.918), 1.9 vs. 0% (p = 0.492), 1.9% vs. 0% (p = 0.492), and 0% vs. 5.3% (p = 0.128) in groups 1 and 2, respectively. There was no hospital mortality in any of study groups. There was no aortic valve prosthesis dysfunction in the early postoperative period.Conclusion. Reconstructive surgeries for ascending aortic aneurysm with simultaneous prosthetics of the tricuspid aortic valve were characterized by satisfactory immediate clinical results comparable to patients with a bicuspid aortic valve.

Life expectancy and early to mid-term dysfunction of transcatheter aortic prostheses: incidence, modes, correlates, and outcome

Abstract Backgrounds Bioprosthetic valve dysfunction (BVD) is a major concern regarding transcatheter aortic valve implantation (TAVI) in low-risk patients. Aims To assess incidence, determinants, modes, and outcome of early to mid-term BVD after TAVI in relation with life expectancy. Methods Consecutive TAVI recipients (2007–2020) with a post-interventional follow-up ≥1-year were prospectively included. BVD components and bioprosthetic valve failure (BVF) were assessed according to updated Valve-Academic-Research-Consortium-3 criteria. Echocardiographic and laboratory follow-up was performed prior to discharge, at 3- and 12-months, and yearly thereafter. BVD/BVF and all-cause death served as endpoints. Average life expectancy was calculated from National Open Health Data and patients were stratified according to tertiles (1st: &amp;lt;6.85y, 2nd: 6.85–9.7y, 3rd: &amp;gt;9.7y). Results Of 1047 patients (81.6±6.8 y/o, 52.7% female, EuroSCORE II 4.5±2.5), ≥2 follow-ups were available from 622 (serial echo cohort). After a median echo follow-up of 12.2 months, incidence rates of BVD and BVF were 8.4% [95% confidence interval 6.7–10.3], and 3.5% [2.5–4.9] per valve-year, respectively, without differences between life expectancy tertiles (Figure 1). BVD incidence was double within the first year of implant (9.9% [7.7–12.6] per valve-year; mostly non-structural VD) vs. beyond (4.8% [3.1–7.2] per valve-year; structural and non-structural VD). Valve-in-valve procedure, and stenosis severity (both p&amp;lt;0.05), but not age/life expectancy (p&amp;gt;0.5) predisposed for BVD. After 4.4±3.0 years, mortality was 36.7%. Time-dependent BVD/BVF were independently associated with outcome for patients in the first (adjusted hazard ratio [AHR] 1.72 [1.06–2.88]/ 2.97 [1.72–6.22]) and second (AHR 1.96 [1.02–3.73]/ 2.31 [1.00–5.30]), but not the third tertile of life expectancy (AHR 1.42 [0.66–3.12]/ 1.84 [0.71–4.79]; Figure 1). Conclusions In this large prospective observational cohort, early to mid-term BVD after TAVI occurred at the same rate across the spectrum of life expectancy and was not prognostic among those with the longest life expectancy. Funding Acknowledgement Type of funding sources: None.

Implante de la prótesis Edwards Intuity Elite en cirugía plurivalvular y en cirugía de revascularización coronaria concomitante

IntroductionConcomitant use of rapid deployment valves is not widespread. A EDWARDS INTUITY Elite valve replacement and concomitant mitral valve replacementent or coronary artery bypass grafting (CABG) were performed. Patients and methodsWe implanted 15 consecutive EDWARDS INTUITY Elite in patients with mitral valve replacement or concomitant CABG. Patients were divided in two groups: Intuity + mitral (8 patients), and Intuity + CC (7 patients). We registered aortic cross-clamp and cardio-pulmonary bypass (CPB) times, and ICU and Hospital length of stay. Two control groups were selected: control + mitral (43 consecutive patients submitted to multiple valve surgery) and control + CC group (48 consecutive patients with aortic replacement and concomitant CABG). Mean and peak intra-prosthesis gradients were calculated before discharge by means trans-thoracic echocardiogram. ResultsThere were no intraoperative complications. Cross-clamp times in Intuity + mitral and Intuity + CC groups were 84,3 ± 10,1 and 67,1 ± 20,7, significantly lower than control groups (117 ± 36,1 y 102,7 ± 27,3) respectively. CPB times in Intuity + mitral were 112 ± 11,6 significantly lower than control group (138,1 ± 43,7). No paravalvular leaks or prosthesis dysfunction were observed. Two patients death during the follow-up. ConclusionsEDWARDS INTUITY Elite prosthesis significantly reduces CPB and cross clamp time when used in multiple valve surgery and cross clamp time in patients with concomitant CABG. The implantation is safe and feasible, and the postoperative intra-prosthetic gradients are adequate.

Aortic valve replacement through minithoracotomy. Results from the Peruvian experience.

To assess mortality, major valve-related events (MAVRE), and other complications in the perioperative period and follow up in patients with aortic valve replacement (AVR) through mini-thoracotomy (MT). We retrospectively analyzed patients aged <80 who underwent AVR through MT between January 2017 and December 2021 in a national reference center in Lima, Peru. Patients undergoing other surgical approaches (mini-sternotomy, etc.), other concomitant cardiac procedures, redo, and emergency surgeries were excluded. We measured the variables (MAVRE, mortality, and other clinical variables) at 30 days and a mean follow-up of 12 months. Fifty-four patients were studied, the median age was 69.5 years, and 65% were women. Aortic valve (AV) stenosis was the main indication for surgery (65%), and bicuspid AV represented 55.6% of cases. At 30-days, MAVRE occurred in two patients (3.7%), with no in-hospital mortality. One patient had an intraoperative ischemic stroke, and one required a permanent pacemaker. No patient underwent reoperation due to prosthesis dysfunction or endocarditis. In a mean follow-up of one year, MAVRE occurrence did not show variations with the perioperative period, most patients remained in NYHA I (90.7%) or II (7.4%) compared to the preoperative period (p<0.001). AV replacement through MT is a safe procedure in our center for patients under 80 years.

In-Hospital Outcomes and Predictors of Mortality for Redo Surgical Mitral Valve Replacement Versus Transcatheter Mitral Valve-in-Valve Replacement

Durability is a major limitation with bioprosthetic heart valves. For mitral valve prosthesis dysfunction, redo surgical mitral valve replacement (rSMVR) has been the mainstay of treatment; however, transcatheter mitral valve-in-valve replacement (mViV) has emerged as a viable alternative. Data comparing these procedures remains limited; therefore, we sought to compare the real-world in-hospital mortality, likelihood of adverse peri-operative outcomes, and predictors of mortality between rSMVR versus mViV using the National Inpatient Sample. During the study period, a weighted total of 1,890 patients (78%) underwent rSMVR, and 520 (22%) underwent mViV. After propensity matching, there were 310 patients in each cohort. There was no statistically significant difference in mortality with these procedures (odds ratio 1.53; 95% confidence interval 0.67 to 3.45; p=0.31). rSMVR was associated with increased length of hospitalization (13 vs 7.5days; p <0.001), increased medical costs ($324,124 vs $241,147; p <0.001), and increased peri-operative complications compared with mViV. Predictors of mortality unique to rSMVR were age >75 years, cirrhosis, sleep apnea, malnourishment/low body mass index, and obesity, signalizing greater suitability for mViV in these populations.

Prosthesis-patient mismatch as a predictor of accelerated structural dysfunction of biological aortic valve prostheses

OBJECTIVE. Identification of predictors of dysfunction of biological aortic valve prostheses in the long-term period after surgical treatment.METHODS AND MATERIALS. We analyzed the completed treatment cases for the period from 2015 to 2020 and echocardiography data of 74 patients (42 men and 32 women) with an average age of 67.0±4.2 years with bioprostheses implanted in the aortic position. The average follow-up period was 4 years. The transaortic flow velocity, the average and peak transvalvular gradients, the area of the effective opening of the prosthesis, the myocardium mass index, the thickness and mobility of the cusp of the biovalve were evaluated. The presence of the pronounced PPM in a patient was determined at iEOA values less than 0.65 cm2/m2, moderate - at values from 0.65 to 0.85 cm2/m2, mild - up to 0.85 cm2/m2.RESULTS. PPM was recorded in 27% of cases. Structural dysfunction was observed in 12.5% of cases, it mainly included stenosis of the bioprosthesis (10%). In 2.5% of cases, reintervention was performed for severe stenosis of the AV bioprosthesis. During the multifactorial analysis, we revealed that PPM was a predictor of the development of structural dysfunction of aortic valve bioprostheses in the long-term period after surgery (p&lt;0.005).